In Reply.—Mallory disagrees with my final statement concerning the treatment of patients with Down syndrome who have syringomas. Unfortunately, she did not quote the entire sentence, which states "It is important for pediatricians to be aware of the significance of syringomas in patients with DS so that they can inform the patient and family of the benign nature of these lesions and not subject the patient to an unnecessary evaluation." This sounds like a very noncontroversial statement to me. Mallory's apparent concern is that most of the diagnoses of syringomas were made on clinical examination and "none of these patients underwent a biopsy of these lesions for verification of the diagnosis." If Mallory believes it is necessary for all such patients to undergo a biopsy, I strongly disagree.

In the beginning of our study we did perform biopsies in some of our patients to confirm the diagnosis. We discontinued this practice